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Medscape
14-05-2025
- Health
- Medscape
Can Chronic Asthma Be Reversed? Experts Reopen the Debate
A new clinical horizon is emerging in asthma management, with the possibility of achieving sustained reversal of the disease and even remission. This involves altering and reversing the progression of diseases that are traditionally considered chronic. This possibility has led to significant therapeutic advances and sparked a clinical debate: Should sustained reversibility be considered a therapeutic goal in its own right or merely as an indirect marker of effective disease control? Reversibility in asthma, understood as the ability to recover pulmonary function and maintain the absence of symptoms, has historically been an elusive goal. Recent research suggests that this challenge may be closer to resolution due to advances in biological therapies and a deeper understanding of the inflammatory phenotypes of asthma. While reversibility remains a central marker in the diagnosis and monitoring of asthma, the scientific community emphasizes that not all patients with asthma experience complete reversibility. The persistence of obstruction may be attributed to structural remodeling of the airways. Clinical Remission Clinical remission is defined as the absence of symptoms and exacerbations for at least 12 months, even without medication. Complete remission is defined as the normalization of pulmonary function and disappearance of bronchial hyper-responsiveness and airway inflammation. However, patients in clinical remission who continue to show elevated inflammatory biomarker levels may still be at risk for future functional decline. Although increasingly achievable in patients treated with biologics, complete remission is still limited by the persistence of certain pathophysiological processes. Airway remodeling in asthma, once it occurs, is difficult to reverse. Achieving complete and sustained disease control is considered the most ambitious goal, while reversibility is a more practical indicator of therapeutic response. Guidelines such as the Global Initiative for Asthma (GINA) and Spanish Guide for Asthma Management (GEMA), recognize the prognostic value of sustained bronchodilator reversibility and its ability to help predict exacerbations but caution against using it alone. Therefore, we recommend incorporating it into a comprehensive assessment that includes symptoms, pulmonary function, rescue medication use, and quality of life. Inflammatory Phenotypes This integrated approach is particularly relevant when considering the dynamic variability of inflammatory phenotypes in asthma. The Spanish MEGA (Mechanism underlying the genesis and evolution of asthma) project analyzed the stability of inflammatory biomarkers and asthma phenotypes. The results confirmed the instability of these phenotypes; although they remained stable during the first year, their instability increased thereafter. The study, led by the Spanish national research consortium CIBERES (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), showed that while 88% of patients initially presented a high T2 phenotype, only 61.3% maintained this classification after 2 years. Similarly, 53.3% of patients had eosinophilic sputum at baseline, but only 37.5% maintained this at 24 months. These findings highlight the need for aggressive therapeutic adjustments. Moreover, the correlations between different inflammatory phenotypes were moderate in the first 2 years but significantly decreased in the third year. Other biomarkers, such as fractional exhaled nitric oxide, total immunoglobulin E, and lung function, did not show significant variations during the study period. These results highlight the fluctuating nature of this disease and the necessity to adapt the therapeutic strategy to each patient's changing inflammatory profile. Mechanical Damage Another recent international study conducted by King's College London, London, England, identified a new pathophysiological mechanism in asthma that should be considered in clinical management. Published in Science , the study revealed that pathological crowding of a broncho constrictive attack causes so much epithelial cell extrusion that it damages the airways, resulting in inflammation and mucous secretion. This previously overlooked process perpetuates the characteristic inflammatory cycle of asthma, as repeated damage to the epithelium promotes chronic inflammation. It also results in scarring and permanent narrowing of the airways, contributing to the progression and severity of the disease. Researchers, including Elena Ortiz-Zapater, PhD, from the University of Valencia, Valencia, Spain, have demonstrated that traditional treatments do not prevent this damage. In contrast, gadolinium, a cell extrusion inhibitor, counteracts mechanical damage and significantly reduces the inflammatory response. Although this breakthrough has only been demonstrated in animal models, it opens new avenues for therapies that not only alleviate asthma symptoms but also prevent structural damage in the airways, offering hope for more durable remission. Biological Therapies Focusing on treatments, biological therapies have marked a turning point in the treatment of severe asthma and type 2 inflammatory phenotypes. This allows many patients to achieve a sustained clinical remission. Some biologics target different inflammatory pathways, demonstrating improvements in baseline pulmonary function and reducing persistent obstruction. Thus, they facilitate more sustained reversibility and even remission in selected subgroups of patients. Targeted drugs, such as omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab, have shown remarkable efficacy. Sustained improvements in pulmonary function, reduced exacerbations, and decreased systemic corticosteroid use have been observed. Recent registries and multicenter studies have shown an increasing number of patients treated with biologics who meet the partial or clinical remission criteria. For instance, the PrecISE trial is evaluating how therapies targeting specific biomarkers such as interleukin (IL)-4/IL-13 and thymic stromal lymphopoietin can induce sustained reversibility in cases of refractory severe asthma. In parallel, new molecules, such as amlitelimab, currently in phase 2 trials, demonstrate prolonged effects, even in phenotypes with mixed inflammation. These agents employ innovative mechanisms, such as targeting the OX40 pathway and using less frequent dosing, which could also facilitate adherence and sustainability of remission. The latest updates from GINA and GEMA have formally incorporated remission as a treatment goal for patients with severe asthma, particularly in the context of biological therapies. A major challenge remains the achievement of complete and sustained remission without chronic treatment, guided by biomarkers, new drugs, and more personalized clinical follow-ups. Short-Acting Beta-2 Agonists (SABAs) Alongside pharmacological advances and strategies for remission, the SABINA study highlights a critical aspect of asthma management. It addresses the inappropriate use of SABAs and their effect on disease control. With over a million patients from 40 countries, including Spain, this is the largest real-world observational analysis of this therapeutic class. The findings showed that approximately 28%-30% of patients with asthma in the country used three or more SABA inhalers annually. This is associated with a higher risk for exacerbations, poor symptom control, and increased mortality. In contrast, 13%-15% of patients use fewer than four inhalers of inhaled corticosteroids annually, which compromises the control of the underlying inflammation. SABAs provide immediate and temporary relief, which may contribute to a cycle of suboptimal control and symptom recurrence. Consequently, the GINA and GEMA guidelines discourage the use of SABA as monotherapy. These guidelines recommend combining inhaled corticosteroids with formoterol (a long-acting beta-2 agonist) as both maintenance and reliever therapy. This combination ensures improved disease management through prevention and continuous anti-inflammatory treatment, which is essential for sustained functional reversibility and clinical remission. Diagnostic Techniques Recent updates in diagnostic techniques have improved the ability to assess asthma reversibility and remission, particularly in patients with nearly normal baseline lung function. The joint guidelines from the European Respiratory Society and the American Thoracic Society recommend that a significant bronchodilator response is an increase of more than 10% in forced expiratory volume in 1 second or forced vital capacity. This adjustment improves the diagnostic sensitivity in patients with asthma, helping to identify cases that might have been previously overlooked and allowing earlier intervention. Additionally, serial spirometry has become a key tool for confirming sustained reversibility, particularly when the initial response to bronchodilators is unclear. This practice of monitoring pulmonary function over time helps assess the effectiveness of treatment and the potential for achieving remission. The integration of these updated diagnostic techniques into clinical practice improves diagnostic accuracy and regulates more personalized therapeutic strategies, increasing the chances of achieving sustained reversibility and, in some cases, complete remission of asthma. In conclusion, the updated assessment of asthma reversibility and remission integrates functional testing, including spirometry, peak expiratory flow, and bronchial provocation testing, inflammatory biomarkers such as fractional exhaled nitric oxide and blood eosinophil counts, and structured clinical follow-up, enabling a more accurate and personalized evaluation of disease status and progression.
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Business Standard
06-05-2025
- Health
- Business Standard
World Asthma Day 2025: Theme, treatment, and tips for better care
Observed globally on May 6, this year's asthma day stresses better access to inhalers, expert-backed prevention, and early diagnosis to reduce global health burden Barkha Mathur New Delhi For the millions living with asthma, the simple act of breathing can be a daily challenge. World Asthma Day 2025, on Tuesday, is a global reminder of the importance of respiratory health and the urgent need to make asthma care accessible to everyone. Whether you live with asthma, care for someone who does, or simply want to learn more, this day puts the spotlight on equitable treatment and empowering communities to take control of their health. What is World Asthma Day and why is it observed globally? World Asthma Day is observed annually on the first Tuesday of May to raise awareness about asthma, a chronic respiratory condition that affects millions of people globally. This year, it falls on May 6. Organised by the Global Initiative for Asthma (GINA), the day highlights the urgent need for accessible, equitable, and effective asthma treatment worldwide. Key asthma symptoms: What to watch for and when to seek help According to the World Health Organization (WHO), asthma is a chronic inflammatory disease of the airways that leads to recurring episodes of breathlessness, wheezing, chest tightness, and coughing. It can vary in severity and frequency, and often worsens during the night or early morning. WHO says the symptoms of asthma can vary from person to person and can sometimes get significantly worse. This is known as an asthma attack. Symptoms are often worse at night or during exercise. Common symptoms of asthma include: A persistent cough, especially at night Wheezing when exhaling and sometimes when inhaling Shortness of breath or difficulty breathing, sometimes even when resting Chest tightness, making it difficult to breathe deeply According to the WHO, over 260 million people are affected by asthma worldwide, and it remains one of the leading causes of non-communicable disease-related deaths, especially in children. Acute vs chronic asthma: Understanding the difference for better care Understanding the types of asthma is crucial for effective treatment. Acute asthma involves sudden and severe airway obstruction, often triggered by infections, allergens, cold air, or stress. It requires immediate intervention to prevent complications. Chronic asthma, on the other hand, is marked by long-standing inflammation and ongoing sensitivity to environmental triggers like dust, smoke, and air pollution. As Dr Anshula Tayal Bansal, Consultant – Paediatric Pulmonology & Intensive Care at Manipal Hospital Goa, explains, 'An understanding of acute and chronic asthma is important for timely and successful intervention in the treatment of a chronic inflammatory disease of the airways, known as asthma, with episodes of acute, reversible airway obstruction.' She underscores the need for accurate diagnosis and personalised care strategies for each type of asthma, especially as unmanaged chronic asthma can lead to irreversible changes in lung function. What causes asthma? Top risk factors you should know Asthma is a complex condition with no single, definitive cause. However, according to WHO, several risk factors have been identified that increase a person's likelihood of developing it: Family history and genetics: Having a close relative with asthma—such as a parent or sibling—significantly raises the risk Allergic conditions: Individuals with conditions like eczema or allergic rhinitis are more likely to develop asthma Urban lifestyle and pollution: Air pollution and limited green spaces contribute to higher asthma rates in urban areas Early life influences: Factors like premature birth, low birth weight, and early respiratory infections increase risk Environmental irritants: Exposure to dust, mould, fumes, and chemicals can worsen symptoms Obesity: Excess weight influences lung function and inflammation, raising asthma risk How to manage asthma: Doctor-recommended tips for symptom control Managing asthma effectively, especially during the warmer months and high-pollution periods, requires both preventive and reactive strategies. Here are expert-recommended tips to help manage symptoms and reduce the risk of attacks: Schedule outdoor activities early in the day when pollution and pollen levels are lower Consult your pulmonologist regularly to adjust medications based on seasonal or lifestyle changes Store inhalers in a cool, shaded place to maintain their efficacy Take controller medications as prescribed, and always keep a rescue inhaler handy Stay hydrated to help thin mucus and ease breathing Monitor local weather and air quality reports, especially during high-smog days Use High-Efficiency Particulate Air (HEPA) filters or air purifiers at home to minimise exposure to allergens and pollutants Why World Asthma Day matters: Global awareness and impact since 1998 World Asthma Day was first held in 1998, with participation from over 35 countries in the first World Asthma Meeting in Barcelona, Spain. It was initiated by GINA to enhance asthma awareness and education globally. Over the years, the day has become a crucial annual event aimed at: Educating the public and patients about asthma Promoting preventive measures and effective treatment Reducing stigma and misinformation Encouraging governments and stakeholders to prioritise asthma care in health policies World Asthma Day 2025 theme: Make inhaled treatments accessible for all This year's theme, 'Make Inhaled Treatments Accessible for ALL', emphasises the need to ensure that essential asthma medications such as inhaled corticosteroids and reliever inhalers are affordable and widely available, especially in low- and middle-income countries (LMICs). Inhaled treatments are crucial for both daily symptom control and emergency relief. Yet, millions around the world lack access due to economic, geographic, and systemic healthcare barriers. The 2025 theme calls on governments, pharmaceutical companies, and international health bodies to improve supply chains, reduce costs, and promote equitable distribution of these life-saving treatments. World Asthma Day initiatives: Awareness, screenings, and community action World Asthma Day sees a wide range of community outreach efforts, including: Free health screenings and lung function tests Public awareness campaigns in schools, workplaces, and public spaces Workshops and webinars by healthcare professionals Social media drives to spread accurate information and support networks These initiatives aim to empower individuals with knowledge about early symptoms, the importance of regular check-ups, and the availability of effective treatments.
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Business Standard
06-05-2025
- Health
- Business Standard
World Asthma Day 2025: India turns to smart tools to tackle high mortality
World Asthma Day 2025: As India battles rising asthma cases driven by pollution and lifestyle shifts, innovations in diagnosis, inhalers, and digital tools are redefining care Barkha Mathur New Delhi It's World Asthma Day 2025, and while millions across the globe are still learning to live with this chronic lung condition, India is seeing a shift in how asthma is understood and treated. From smart inhalers and digital health tools to better patient education, the country is inching closer to personalised, effective asthma care. But even as metros embrace smart tech and biologics, questions of access, awareness, and affordability still loom large, especially outside urban centres. Why World Asthma Day 2025 matters more than ever World Asthma Day, observed every year on the first Tuesday of May, is an initiative led by the Global Initiative for Asthma (GINA) to raise awareness and improve asthma care around the world. The theme for 2025, 'Make inhaled treatments accessible for all', emphasises the need for universal access to essential asthma medications. India accounts for highest asthma deaths despite lower prevalence According to GINA, asthma is one of the most common chronic non-communicable diseases that affects over 260 million people and is responsible for over 450,000 deaths each year worldwide. In India, the asthma burden is particularly alarming. The country accounts for nearly 13 per cent of the global asthma prevalence and a staggering 46 per cent of global asthma-related deaths, according to the latest Global Burden of Disease 2021 Report. ALSO READ | An April 2024 paper published in the PubMed Central journal at the US National Institutes of Health's National Library of Medicine explains that despite not having the highest number of asthma patients, India's mortality rate is disproportionately high due to underdiagnosis, poor disease control, and limited access to essential medications. A 2024 study noted that India's asthma-related mortality rate is three times higher than the global average, and the country also bears more than double the global burden in terms of disability-adjusted life years (DALYs). These numbers aren't just statistics, they represent millions of people whose daily lives are disrupted due to poor air quality, smoking, misinformation, and limited access to specialised care. 'Asthma is becoming increasingly common in India, especially in the northern parts, due to high pollution levels and rising rates of smoking among adolescents,' says Dr Gyanendra Agrawal, Director of Respiratory & Critical Care Medicine, Max Super Speciality Hospital, Noida. From diagnosis to drugs: India shifts to precision asthma treatment Asthma care in India has seen a major evolution in recent years, with a shift from generic treatments to personalised, technology-driven approaches. 'India has seen a noteworthy shift in asthma care, moving from symptomatic relief to precision-driven management,' says Dr Arjun Khanna, Senior Consultant & Head, Pulmonology Department, Amrita Hospital, Faridabad. 'Advances like FeNO testing (or exhaled nitric oxide test) to determine lung inflammation, impulse oscillometry, high-resolution CT scans and biologics like anti-IgE (antibody that specifically targets immunoglobulin E) and anti-IL5 therapies (such as mepolizumab, benralizumab, and reslizumab, are monoclonal antibodies that target interleukin-5) have transformed how we diagnose and treat asthma.' 'These biologics have significantly helped difficult-to-treat asthma patients. They reduce flare-ups and decrease the need for steroids,' Dr Agrawal explains. Asthma treatment cost in India: Biologics remain unaffordable for many The cost of asthma treatment in India varies widely depending on the severity of the condition and the specific treatment approach. Annual expenses can range from ₹18,737 to ₹1,18,303, influenced by factors such as medication requirements and hospitalisation needs. Asthma treatment costs Treatment Type Estimated cost Notes Standard Inhalers ₹380 – ₹1,100 Preventive inhalers; prices vary by brand and dosage. Smart Inhalers ₹850 – ₹1,050 Advanced inhalers with features like dose counters. Biologic Therapies ₹8,000 – ₹28,000 per dose Used for severe asthma; cost varies by medication type. Doctor Consultation ₹500 – ₹2,000 per visit Fees depend on the healthcare facility and specialist. Nebulizers (Home Use) ₹3,000 – ₹5,000 Devices for administering medication in mist form. Bronchial Thermoplasty Up to ₹10,00,000 Advanced procedure for severe cases; available in select centers. Smart inhalers and mobile apps improve medication adherence Inhalers remain the backbone of asthma treatment, but their design and delivery mechanisms have significantly improved. 'Next-generation inhalers such as Dry Powder Inhalers (DPIs) ensure better drug delivery and patient compliance,' Dr Khanna explains. 'Smart inhalers with Bluetooth connectivity are also helping doctors and patients track usage and effectiveness in real-time.' Dr Gyanendra Agrawal, Director–Respiratory & Critical Care Medicine, Max Hospital, Noida, agrees that modern tools are making asthma management easier and more effective. 'Mobile apps now allow patients to log symptoms, track peak flow rates, and receive reminders for medication,' Dr Agrawal says. 'This improves long-term adherence and allows doctors to adjust treatment based on real-world data.' India's asthma tech advances still slow to reach rural populations Despite these advances, a significant portion of India's population, especially in tier 2 and 3 cities and rural areas, still struggles with access. 'Urban centres have embraced advanced options, but tier 2 and 3 cities are catching up slowly,' Dr Khanna notes. 'Telepulmonology, mobile respiratory clinics, and government drug programs are beginning to bridge the gap.'
New Indian Express
06-05-2025
- Health
- New Indian Express
35 million suffer from asthma in India: Report
HYDERABAD: With the growing burden of asthma worldwide as one of the most chronic non-communicable diseases (NCD), the global Initiative for Asthma (GINA) has given the theme of 'Make Inhaled Treatments Accessible for ALL' on the World Asthma Day to be observed on May 6. As per the Global Asthma Report 2022 by the Global Asthma Network, about 35 million people in India suffer from asthma and 4,50,000 die of the disease every year across the globe. Asthma has been found to be a leading cause of morbidity and mortality in rural India and is expected to increase in the coming decades. According to doctors, the disease is usually triggered during the winter season, but in recent times, asthmatic patients are seen in hospitals throughout the year.
NDTV
06-05-2025
- Health
- NDTV
World Asthma Day 2025: Can Breathing Exercises Help In Asthma Management?
World Asthma Day is observed every year on the first Tuesday of May to raise awareness about asthma, improve care, and support those affected by the condition. It is organised by the Global Initiative for Asthma (GINA), and each year focuses on a specific theme aimed at improving understanding and management of asthma globally. A key part of asthma management involves non-pharmacological strategies like breathing exercises, which can help patients control symptoms and improve quality of life. Breathing exercises help in asthma management by training the respiratory muscles, reducing hyperventilation, and promoting relaxed, efficient breathing. Asthma often causes the airways to become inflamed and constricted, making it difficult to breathe. In response, many people develop rapid or shallow breathing patterns, which can worsen symptoms like breathlessness and anxiety. Breathing exercises help to slow down the breathing rate, increase lung capacity, and improve oxygen exchange. They also aid in loosening mucus trapped in the airways, reducing the frequency and severity of asthma attacks. Over time, consistent practice can enhance the individual's sense of control over their breathing, reduce reliance on medication during mild episodes, and improve overall lung function. Read on as we share a list of breathing exercises you can perform to better management asthma. Breathing exercises that help in asthma management 1. Pursed-lip breathing This technique helps keep the airways open longer by creating slight resistance during exhalation. It reduces the rate of breathing and improves airflow in and out of the lungs. Inhale slowly through your nose for 2 seconds. Purse your lips (as if blowing out a candle). Exhale slowly and gently through pursed lips for 4 seconds. Repeat for several minutes. 2. Diaphragmatic breathing It focuses on using the diaphragm to breathe instead of shallow chest breathing, which is common during asthma episodes. Sit or lie down comfortably. Place one hand on your chest and the other on your belly. Inhale slowly through your nose, letting your belly rise (not the chest). Exhale slowly through pursed lips, feeling your belly fall. Practice for 5–10 minutes daily. 3. Buteyko breathing technique Designed to reduce hyperventilation and normalise breathing patterns through shallow, nasal breathing. Sit upright in a calm environment. Breathe in gently through your nose and out slowly. After exhaling, pinch your nose and hold your breath until you feel the urge to breathe. Release and breathe gently again. Repeat a few times under supervision. 4. Yoga pranayama This is a form of alternate nostril breathing used in yoga to balance energy flow and calm the mind. Sit in a meditative pose with a straight spine. Close the right nostril with your thumb and inhale through the left. Close the left nostril with your ring finger, open the right, and exhale. Inhale through the right nostril, close it, and exhale through the left. Continue for 5–10 minutes. Practicing these exercises regularly, under the guidance of a respiratory therapist or trained professional, can significantly support asthma control alongside prescribed medical treatment. Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
